My job description this month calls for a lot of independent assessment, decision making, and interaction with the attendings. Half the time, I have to call very senior staff by myself, no junior resident to run things by first, and I find them making their decision based on my reporting. Apart from burns (where I knew the nurses knew almost everything, and would tell me what they thought needed to be done), this is the first time I’ve had so much responsibility. I spend a lot of time agonizing over whether it’s worth calling the attending with this issue, or whether it can wait; whether I’ll get in more trouble for waking him up at 1am and it turns out to be nothing, or more trouble if I don’t call and then things go bad; whether I’ve gathered absolutely every single piece of relevant data before I wake someone up; whether I’ve thought of every single question that I need answered, before I call. Not much fun, even when the patients aren’t particularly sick; I can’t wait to see what happens when there’s real trouble.

Plus, I find myself with interests opposed to those of the other surgery residents (my supervisors now want the patients admitted to general surgery, and general surgery of course doesn’t want to admit them). So I’m stuck between trying to please the people on the other end of the phone, to whom I’m technically and legally responsible, and trying to please my fellow residents, who are very much present right in front of me, and very much displeased with my actions the last few nights. And when they’re not happy, they let me know.

So, what with getting grief from all sides for just about every decision I make (and questions from my conscience, even when no one else is talking), I was tremendously pleased to be validated by the attendings this last night. I forced general surgery to get involved, over the vociferous protests of the other residents, who insisted there was no call to make extra work for them. This went on until the attendings got called, and suddenly they agreed with my assessment more than with anyone else’s, and acted on it. Very satisfying. I didn’t have all the right reasons for making my decision, and the end result didn’t completely bear me out, so I won’t be able to gloat at the other residents about it, but maybe it will keep them from mocking me for the next couple of nights.

The in-training exam results are back. It is very salutary to finally find myself, for the first time in my life, in company where I am only average on tests. New, surprising, not altogether pleasant, but very healthy. (Now it’s time to start studying for next year. . . I wish I could get past this competitive attitude. . . but at last I’m finally studying information that will be truly valuable to my patients, so however I get motivated, it’s not such a bad thing. . . )